Biologic response of local hemostatic agents used in endodontic microsurgery

Abstract

Appropriate use of local hemostatic agent is one of the important factors on the prognosis of endodontic microsurgery. However, most investigations to date focus on the hemostatic efficacy of the agents, whereas their biologic characteristics have not received enough attention. The purpose of this paper was to review the biologic response of local hemostatic agents, and to provide clinical guidelines on their use during endodontic microsurgery. Electronic database (PUBMED) was screened to search related studies from 1980 to 2013, and 8 clinical studies and 18 animal studies were identified. Among the materials used in these studies, most widely-investigated and used materials, epinephrine, ferric sulfate (FS) and calcium sulfate (CS), were thoroughly discussed. Influence of these materials on local tissue and systemic condition, such as inflammatory and foreign body reaction, local ischemia, dyspigmentation, delayed or enhanced bone and soft tissue healing, and potential cardiovascular complications were assessed. Additionally, biological property of their carrier materials, cotton pellet and absorbable collagen, were also discussed. Clinicians should be aware of the biologic properties of local hemostatic agents and their carrier materials, and should pay attention to the potential complications when using them in endodontic microsurgery.

Guía De Práctica Clínica Para El Manejo Quirúrgico en Endodoncia De La Enfermedad Periapical Postratamiento

“…The use of aluminum chloride for hemostasis control in apical surgery is not recommended, as reactions to external bodies may occur if certain precautions are not taken during removal. 46 THEORETICAL SUMMARY: A retrograde filling material must have dimensional stability, adequate adhesion to the canal walls, moisture strength, and biological stability, and it should promote the healing of periapical tissues. 41 A proper and durable apical seal is required for apical repair in EM.…”

Clinical applications of ferric sulfate in dentistry: A narrative review

“…Epinephrine pellets used either alone or in combination with a FS-soaked pellet are effective topical hemostats when applied in the bony crypt under light pressure. [ 38 ] Aluminum chloride alone or in combination with FS (Stasis ® ) appeared to be the most efficient hemostatic agent to control the bleeding during periapical surgery. [ 15 39 ]…”

Effect of the plant-based hemostatic agent Ankaferd Blood Stopper® on the biocompatibility of mineral trioxide aggregate

“…Reactions in tissues caused by hemostatic agents are important for the reliability of the materials used [ 20 , 21 ]. Although ABS is widely used in endodontic surgery as a hemostatic agent [ 13 ], data regarding to its effects on root-end filling materials in animal experiments (devised for the investigation of their biocompatibility) are lacking.…”